Terms in Skin Diseases and their Definitions

Terms Used in Skin Diseases and their Definitions:-

Macule- Small flat area of altered color or texture

Papule- Small solid elevation of skin, less than .5 cm in diameter

Nodule- A solid mass in skin, greater than .5 cm in diameter

Plaque- Elevated area of skin greater than 2 cm in diameter but without substantial depth

Vesicle- Circumscribed elevation of skin , less than .5 cm in diameter and containing fluid

Bulla- Circumscribed elevation of skin over .5 cm in diameter and containing fluid

Pustule- A visible accumulation of pus in skin

Abscess- A localized collection of Pus in a cavity. More than 1 cm in diameter

Wheal- An elevated white compressible , evanescent area produced by dermal edema

Papilloma- A nipple like mass projecting from skin

Petechiae- Pinhead size macules due to bleeding in skin

Purpura- Large area of bleeding in skin

Ecchymosis- A larger extravasation of blood into skin

Hematoma- A swelling from gross bleeding

Burrow- A linear or curvilinear papule, caused by a burrowing scabies mite

Comedo- A plug of keratin and Sebum wedged in a dilated pilosebaceous orifice

Telangiectasia- The visible dilation of small cutaneous blood vessels

Scale- A flake rising from the horny layer

Crust – Looks like a scale but is composed of dried blood or tissue fluid

Erosion- An area of skin denuded by a complete or partial loss of the Epidermis

Ulcer- An area of skin from which the whole of the epidermis ( Uppermost layer of skin) and at least the upper part of Dermis ( Inner layer of skin below epidermis) is lost

Excoriation- An ulcer or erosion produced by scratching

Fissure- A slit in the skin

Sinus- A cavity or channel that permits the escape of pus or fluid

Scar- The result of healing in which normal structures are permanently replaced by fibrous tissue

Atrophy- Thinning of skin due to diminution of the epidermis ,dermis, subcutaneous fat

Stria - A streak like linear, atrophic, pink, purple or white lesion of the skin due to changes in the connective tissue

Homeopathic Medicines for problems during Pregnancy

Different Complaints during Pregnancy and their Indicated Homeopathic Medicine



Pregnancy brings so many complaints and sensation during it's course. There are few very common problems and their indicated Homeopathic medicines are given. Please use medicines only after consultation with a Homeopath. If it is not possible for you to consult any homeopath, then consult us on consulthomeopathy@gmail.com



Aversion to company during Pregnancy-
Lachesis

Black discoloration of face during Pregnancy-
Phosphorus

Coldness of Skin during Pregnancy-
Nux Moschata

Constipation during Pregnancy-

Ist Grade- Dolicohos, Natrum Sulph, Nux Vomica, Plumbum Metallicum, Platina, Sepia
IInd Grade- Agaricus, Alumina, Ambra G., Antimonium Crud, Apis, Bryonia, Colocynthis, Conium, Hydrastis can, Lycopoduim, Opium, Podophyllum, Pulsatilla, Sulphur

Convulsion during Pregnancy-
Cedran, Chammomilla, Cicuta Virosa, Cuprum Met, Hyoscyamus

Cough during Pregnancy-
Causticum, Conium, Nux Moschata

Cramps in calf muscles during Pregnancy-
Sepia

Cramps extremities during Pregnancy-
Cuprum Metallicum, Vertarum Album

Cramps Legs during Pregnancy-
Gelsemium, Hamamelis, Vibrunum Oppulus

Cramps stomach during Pregnancy-
Conium

Diarrhea during Pregnancy-

Ist Grade- Phosphorus
IInd Grade- Antimonium Crude, Chelidonium, China Officinalis, Lycopodium, Nux Moschata, Pulsatilla, Sepia, Sulphur

Discoloration of skin during Pregnancy-
Aurum Metallicum, Phosphorus

Erysipelas during Pregnancy-
Borax

Falling of Hair during Pregnancy-
Lachesis

Faintness during Pregnancy-
Belladona, Nux moschata, Nux Vomica, Pulsatilla, Sepia

Fear of Death during Pregnancy-
Aconite

Frequency of urination during Pregnancy-
Podophyllum

Hemorrhoids during Pregnancy-
Aesculus, Ammonium Mur, Capsicum, Colocynthis, Lachesis, Lycopodium, Natrum Mur, Nux Vomica, Sulphur

Headache during Pregnancy-
Belladona, Chammomila, Pulsatilla, Sepia

Hiccough during Pregnancy-
Cyclamen Europa, Opium

Involuntary Urination during Pregnancy-
Arsenicm Album, Kresotum, Pulsatilla, Natrum Mur, Sepia

Itching of female genitals during Pregnancy-
Caladium, Acid Flour, Helonias, Mercuris Sol, Sepia

Leucorrhoea during Pregnancy-

Ist Grade- Kreosotum, Sepia
IInd Grade- Cocculus Indica, Murex, Pulsatilla

Menses during Pregnancy-
Cocculus, Kali Carb, Kreosotum, Nux Vomica, Phosphorus, Platina, Rhus Tox, Secale Cor.

Movement of fetus disturbing sleep during Pregnancy-
Conium

Nausea and Vomiting during Pregnancy-
Asarum, Kreosotum, Lactic Acid, Nux Vomica, Sepia, Tabacum

Nymphomania during Pregnancy-
Belladona, Lachesis, Mercuris Sol, Platina, Pulsatilla, Stramonium, Vertarum Alb.

Pain abdomen during Pregnancy-
Arnica,Arsenicum Album, Belladona, Bryonia, Chammomila, Colocynthis, Conium, Ipecacunha, Kali Carb, Nux Vomica, Vertarum Album

Palpitation during Pregnancy-

Ist Grade- Lilum Tig.
IInd Grade- Argentum Metallicum, Conium, Laurocerasus, Natrum Mur, Sepia

Pulsation body during Pregnancy-
Kali Carb

Sadness during Pregnancy-
Cimicifuga, Lachesis, Natrum Mur

Sleepiness during Pregnancy-
IInd Grade- Helonias, Nux Moschata

Toothache during Pregnancy-

Ist Grade- Lyssin, Sepia
IInd Grade- Aconite, Belladona, Calcarea Carb, Chamomilla,Hyoscyamus, Magnesium Carb, Mercurius Sol, Nux Moschata, Pulsatilla, Ratanhia, Staphysigria, Tabacum

Varicose Veins during Pregnancy-

Ist Grade- Ferrum met, Pulsatilla
IInd grade- Lycopodium, Lycops Virginica, Millefolium, Zincum Met

Vertigo during Pregnancy-
Ist Grade- Natrum Mur
IInd Grade- Gelsemium

Grading of medicines in Homeopathy is a system to emphasis on that medicine's work efficiency on that particular symptom.

Homeopathic Medicines for Injuries

Homeopathic Medicines for Injuries of different tissues and organs


Injuries -

Blows,falls,bruises :-
Ist Grade- Arnica, Conium, Hypericum, Pulsatilla, Rhus Tox, Sulfuric Acid.
II nd Grade- Badiaga , Cicuta, Dulcamara, Iodum, Lachesis, Ledum, Phosphorus, Ruta, Silicea, Staphsigaria, Sulphur, Symphtum

Bone Injuries-
Ist Grade- Ruta
IInd Grade- Sulphuric Acid

Breast Injuries-
IInd Grade- , Conium

Coccyx Injury-
Ist Grade- Hypericum

Glands Injury-
Ist Grade- Conium
IInd Grade- Arnica, Dulcamara, Iodum, Phosphorus, Silicea

Nerves Injury-
Ist Grade- Hypericum
IInd Grade- Phosphorus

Periosteum Injury-
IInd Grade- Ruta

Soft Part Injury-
Ist Grade- Arnica, Conium
IInd Grade- Pulsatilla

Spinal Injury-
Ist Grade- Hypericum, Natrum Sulph
IInd Grade- Apis, Arnica, Berberis, Calcarea, Conium, Ledum Paul, Nitric Acid, Rhus Tox, Ruta, Silicea, Thuja

Tendon Injury-
IInd Grade- Anacardium

Post Operative-
Acetic Acid, Bellis P, Calendula, Camphor, Cocculus, Hypericum, Millifolium, Staphsigaria, Strontium Carb, Vertarum

Abortion ,Injury From-
Arnica, Rhus Tox

Back pain from Injury-
Ist Grade- Hypericum
IInd Grade- Conium, Kali Carb, Natrum Sulph, Rhus Tox, Thuja

Bladder Inflammation After Injury-
IInd Grade- Arnica, Staphsigaria

Confusion After Head Injury-
Ist Grade- Natrum Sulph

Constipation after Injury-
Arnica, Ruta

Convulsions from Injury-
Ist Grade- Hypericum
IInd Grade- Cicuta V., Natrum Sulph, Opium, Rhus Tox

Cough After Injury-
Arnica, Millefolium

Debility from Injury-
Acetic Acid, Arnica, Calendula, Carbo Animalis , Sulphuric Acid

Deeper Tissue Injury after Surgery-
Bellis P.

Diarrhea from Injury-
Arnica

Epilepsy From Injury-
Natrum Sulph, Conium, Cuprum mettalicum, Mellilotus

Epistaxis After Injury-
Acetic Acid, Arnica, Elaps, Hamamelis, Sepia

Eye Inflammation after Injury-
IInd Grade- Arnica,Hamamelis, Heper Sulph, Pulsatilla, Sulphur

Glaucoma After eye operation-
Physostigma

Hemorrhages after Injury-
IInd Grade- Arnica, Hamamelis, Millefolium, Trillium

Headache After Injury-
Ist Grade- Natrum Sulph
IId Grade- Arnica,Belladona, Hepar Sulph, Hypericum, Natrum Mur, Phosphorus, Pulsatilla, Rhus Tox

Long Lasting effect From imjuries-
Arnica, Conium, Gloninum, Natrum Sulph

Mental Disorder After Injury-
IInd Grade- Gloninum, Natrum Sulph

Metrorrhagia from injury-
Arnica, Rhus Tox, Ruta, Secale Cor.

Sadness After Head Injury-
Cicuta V, Natrum Sulph

Sciatica After Injury-
Arnica, Hypericum

Shock After Injury-
Ist Grade- Aconite, Arnica, Camphor, Hypericum, Lachesis, Opium, Veratrum Album
IInd Grade- Capsicum, Carbo Veg, Chamommila, Cicuta V, Cocculus, Coffea, Cuprum Mettalicum, Gelsemium, Staphsigaria

Vertigo After Head Injury-
Cicuta, Natrum Sulph


Grading is a system in Homeopathy to emphasis the action of that medicine in particular condition. In Homeopathy single medicine indicate in different type of symptoms.

Leukoderma ( Vitiligo)

Colour of our skin, hairs and iris(eye) is depend on Melanin pigment. Melanin is produced by melanocytes, these are cells in skin layers which works under control of Melanocyte Secretory Hormone from brain. When these melanocytes reduce production of Melanin pigment, skin starts to loss it's colour and becomes white. 

There are many disorders which are caused by deficiency of pigmentation of skin, and they all are grossly known as Leukoderma. Few disorders are caused by inability to produce Melanin pigment by Melanocytes ( Melanin producing cells), while other disorders are caused by absence of Melanocyte cells or due to destruction of melanocytes later on.

In Vitiligo Melanocytes starts to destroy and reduce the pigmentation of skin. Clinically vitiligo appears as milky-white, irregularly oval patches of skin. These patches are more or less symmetrical. Most common places are hands, wrists, face, neck, knee and various openings of body as around eyes, lips, nose etc. These patches are small at beginning but enlarge gradually. Hairs growing in these patchy area also lost their colour and becomes white. The exact reason of Vitiligo not yet clear. But many theories are proposed for this condition.

At least 1% of population, world wide suffers by Vitiligo.


Production of Melanin-


The melanocyte cells transform the peptide tyrosinase into two different forms of melanin, which is spread throughout the dermal cells and the keratinocytes via melanosomes to darken tissue.


Causes of Vitiligo


Many theories are described about causation.


A. Autoimmune Theory-

It is known vitiligo appears in conjunction with several other autoimmune disorders, such as juvenile Diabetes Mellitus, Addison's disease, Pernicious Anemia and additionally organ-specific antibodies can often be seen in patients with vitiligo. Now this theory is accepted as most common cause of Vitiligo. 

Autoimmune disease means, body's own immune system develops antibodies against Melanocyte cells, which start to destroy them. Few other Autoimmune diseases may be present in cases of Vitiligo as - Pernicious Anemia, Diabetes Mellitus and disorders of Thyroid.


B. Genetic theory-

About 20% patients have strong family history of Vitiligo. Genetic factors probably play a key role in the pathogenesis of vitiligo, but the exact cause is unknown.


C. Self Destruct Theory-

In process of producing melanocyte pigment, melanocytes produce some pre-metabolites as dopa and dopachrome. These metabolites are toxic for Melanocytes,but usually Melanocytes have counteract measures against these substances. But sometimes Melanocytes lost this ability to counteract these toxic substances. In that condition Melanocytes destroyed by these toxic substances.


D. Neural theory-

Sometimes peripheral nerves endings may secrete some cytotoxic substances which damage melanocytes. This theory is supported by cases of segmental vitiligo, in which a whole dermatone is hypo-pigmented due to destruction of melanocytes in that dermatone.


E. Convergence Theory-

After genetic studies, researchers have begun to lean towards a multi-faceted etiology for vitiligo. This theory states that genetic influences have a role in causing vitiligo in addition to other elements, such as stress, accumulation of toxic compounds, infection, autoimmunity, mutations, and impaired melanocyte proliferation.




Factors Important from Homeopathic Point of view-


A. In some cases Mental state of patients as- shock, anxiety, tension, depression, constant grief may cause changes in skin pigmentation.


B. Suppression of other skin diseases, cauterization for skin growths like warts, moles, lot of external application of strong chemicals on skin may cause vitiligo.


C. Melanin formation depends on enzyme Tyrosinase activity. Normal vitamin levels are prerequisite for tyrosinase activity.


D. Intestinal disturbances and infections as Chronic amoebic dysentery and intestinal giardiasis may cause mal-absorption of tyrosin, which is an important substance for melain pigmentation.


E. Family history of Vitiligo, Tuberculosis and Diabetes is very important for Homeopathic treatment.


Treatment-


Modern allopathic science offer following way of treatment-


1. Immuno suppressive treatment- Because vitiligo is a autoimmune disorder,so topical Corticosteroids are used to cure small vitiligo patches. But in big patches systemic corticosteroids therapy may be more harmful due to its side effects in comparison to its benefit.


2. Phototherapy and Photo-chemotherapy-
Many artificial ultra violet radiation ( UV) methods are offered with less and more success. Among them PUVA, BUBV,NBUVB and Laser methods are used.


3. Surgical Treatment-

Grafting of skin patches with melanocytes is done for pigmentation of Vitiligo patches.


Homeopathic Treatment-


Scope- Homeopathy cures 60% cases of Vitiligo in 1 to 3 years. Another 25% cases which continue Homeopathic Treatment for 3 years show very good recovery for 80% spots . 15% cases which have very large and bilateral de-pigmented spots never get good recovery. 

For permanent cure by Homeopathy it needs to start treatment earliest, continue it for 1 to 3 years, cases which are bilateral takes longer time, big spots take much time and patience is needed.


There are numerous medicines for Vitiligo. Few are described here.


A. Thuja- It is an Anti Sycotic medicine . In homeopathy all the chronic diseases are supposed to be born from any one of the three Miasms - Psora,Sycosis,Syphilis.
In cases where Vitiligo develops after Vaccinations and recurrent inoculations, Thuja works very finely. In cases where other skin growths like warts are present with Vitiligo lesions Thuja helps. In cases with history of Tuberculosis, where Bacilinium is prescribed, Thuja must be given first, cause Bacilinium works very good after Thuja.


B. Sulphur- It ia great Anti Psoric medicine. This medicine is indicated where there is - History of suppressed Sycotic and Syphilitic miasmatic symptoms, suppressed diarrhea, Dysentery, Jaundice, Typhoid fevers etc. Symptoms of sulphur must be present in the case as- Burning soles, palms, heat in eyes, anus, vagina or other openings of body. Irritable and obstinate person. Sometimes this medicine can aggravate the symptoms, in that case Sulphur must be stopped.


C. Bacillinum- In cases where history or family history of Chest diseases found as Tuberculosis, Asthma, Bronchitis, Pneumonia, Pleurisy. Present symptoms may be Loss of weight, Loss of appetite, Flat chest, Prominent ribs and clavicle.


D. Cuprum Aceticum- Cuprum is important part of melanin pigment. And most of the time Copper deficiency is found with Vitiligo. This medicine show very impressive and remarkable results in many cases.


E. Sepia- In female Vitiligo patients Sepia is indicated very frequently. Where coexisting symptoms are irregular menses,scanty and painful menses, leucorrhea, pruritis, dysparunia and patient is very cold .

Nausea, morning sickness, vomiting, motion sickness, headache all these symptoms indicate Sepia. But sepia does not cure completely a patient and many of times Natrum Mur is needed to complete the recovery started by Sepia.


H. Hydrocotyle- is indicated in cases of suppressed skin eruptions. It is very helpful in cases where history of filariasis is present.


I. Acid Nitricum- This medicine indicated where spots of vitiligo found on muco-cutaneous junction as lips, nose, nipples, glans penis, vulva etc. Cracks may coexist with these white spots. In patients with desire to eat strange things as chalk, pencils etc. indicate towards Acid Nitricum.


J. Mercuris Sol- In patients with history of dysentery with mucus and blood. Patient which feel worse in night, extreme salivation in night, perspiration in night in bed. Patients of mercuris sol can not tolerate both extreme cold and hot weathers.


K. Ars. Sulf. Flav.- This medicine is used very much ,even in cases which are not indicated for this medicine. Patients who are -very irritable,quarrelsome,fear at night in dark, very suspicious, weeping in night, aversion from milk, desire warm things to eat, itching worse in cold weather and better by warmth of bed- only indicated for this medicine with marvelous outcome.


L. Cantharis V - This medicine is indicated in cases where Vitiligo start after burn in some part. Cases where injury on skin caused by Burn starts whiting of skin can be cured by this medicine.


M. Ami Vishnaga- This medicine is used externally on vitiligo spots in Mother tincture form. External use increase the rate of improvement.


Beside these medicines Syphilinum, Medorrhinum, Natrum Mur, Lycopodium, Ars Iod, Cobalt and so many other medicines help to recover the vitiligo spots.

Comparison of Bryonia,Nux Vomia,Pulsatilla In Gastric Disorders

1. All these three medicines have Sensation as of a stone in stomach. But pulsatilla has less in sensation as compare to other two medicines.

2. Bryonia leads in thirst, needs large quantities of water, Pulsatilla needs very little or no thirst.

3. Bad taste in mouth is common symptom in all three medicines, here Nux vomica has Sour taste and Bryonia and Pulsatilla has bitter taste.

4. Causation of gastric disorder are quite different in these medicines. Bryonia disorders are due to dietetic errors when warm weather starts after colds. Pulsatilla disorders are due to Rich food, Pastries, Fatty food, Ice Cream. Nux vomica disorders are result of Over eating, inactivity, drugs abuse, tobacco, coffee, alcohol , in brief we can say high living.

5. All these medicines have Nausea,Vomiting, diarrhea. Bryonia symptoms are worse on motion, on rising from bed. Nux vomica symptoms are worse in morning and due to overeating. Pulsatilla symptoms are worse in evening and night , worse by eating. Nux vomica diarrhea is dysenteric type and pulsatilla diarrhea is with great rumbling.

6. All these medicines have Thick,white coating on tongue but modalities, temperament, causation differ these medicines.

7. Nux vomica likes covering always, Pulsatilla better in open air and Bryonia worse when hot weather starts after colds.

Pain,Painkillers and Homeopathy

Presented By:

Dr. Ravinder S. Mann
Dr. Vandana Patni

Pain is the most common symptom which compel patients to consult physician. Severe pains has many causes some are permanently curable others have chronic causes which are not easily curable. Pain killers are most common over the counter(OTC) selling drugs. Most common causes of pain for which patients taking pain killers are Recurring Headache/Migraine, Arthritis, Backache. These days we see painkillers as a normal part of everyday life. There are three(3) category of main Pain killers in Modern medicine (Allopathy).


1. NSAIDs (Non steroidal anti inflammatory drugs)- Aspirin and ibuprofen are two most used drugs of this category. These drugs reduce Pain, Inflammation, Fever - so it is used in arthritis, backache, rheumatism, headache, period pains. Low dose of aspirin in daily dose can thin the blood,so it reduce risk of clots that can lead to heart attack and stroke. Ibuprofen and aspirin also protect against breast cancer, cancer of mouth, colon, throat and esophagus up to some extent.
Possible side effects of NSAIDs are Ulcers of stomach, bleeding from ulcers, Asthmatic Attacks, renal failure and these medicines may interact with another medicines badly, can damage unborn child (not safe in pregnancy). If you take these medicines longer over months ,side effects may be manifold.


2. Paracetamol- It is not NSAIDs. It is supposed to be safest painkiller. But mild overdoses may be fatal. It reduce only Pain and Fever but does not relieve inflammation. People using very frequently and erroneously even in children as CALPOL( infant paracetamol) for "preventing" night time waking.
Mild overdose may damage liver. An overdose of 15 g may cause fatal liver damage. If anyone has already poor liver functions or an alcoholic then these side effects may be more severe.


3. Opoids- Codeine is one of the stronger pain killers related to "Morphine". It is very effective even in severe pains. But it has more side effects as Nausea, Vomiting, Drowsiness, Constipation, Itching, Dry Mouth, Sweating and Hallucination. Beside all these side effects codeine may develop addiction.


Few Rules about pain killers:-


1. Always take prescribed Painkillers by your Physician.
2. Always follow dosages written on bottle if you use pain killers for 2-3 days without advise of your doctor.
3. In chronic pain conditions, always talk to your doctor about long term therapy, don't forget to discuss risks with benefits.
4. Pain killers may be effective but they are not risk free.




Role of homeopathy in Pain management:-


Homeopathic medicine are prescribed in very minute doses. These medicines does not work directly on nerves to desensitize pain. But homeopathic medicines try to remove the cause behind pain. It means homeopathic medicines have capacity to cure the long term chronic diseases. Many of the cases of Migraine, Chronic headache, Backache, Arthritis, Spondylitis, Period pains in women are curable permanently .

Homeopathic medicines can not be used simply as pain killers to reduce pain whenever needed. But homeopathic medicine must be taken continually as prescribed by Homeopath. Homeopathy has more then 310 medicines for different type of pains. But homeopathic medicines can only be prescribe on individuality of each patient according the modalities (it means the conditions aggravating or ameliorating the pain), location, sensation, severity, coexisting symptoms with pain. There are no common painkillers as in conventional medicine.

What pain conditions are curable by homeopathy?

For peoples who have not used the homeopathy in pain, may not believe it easily. The most severe pain of kidney stones, specially when stone stick in ureter and causes severe spasmodic pains, are stopped very quickly and efficiently by homeopathic medicine. 

Most wild pain of migraine or headache, when a patient has already took 1000 mg of paracetamol and not even better, then few pills of homeopathic medicine improve in few minutes. 

Cramping pains of intestinal colic with diarrhea, vomiting and fever can be stopped in minutes by homeopathic medicine while other medicines can not be tolerated due to immediate vomiting reflex by patient. 

Whenever you have severe burning pains in stomach, burning behind sternum or acrid and sour eructations, go for a homeopath, not only your pains will get better but your chronic and recurring dyspepsia will improve finally by homeopathic medicines.

So next time when you get pain either it is severe and acute like an emergency or a chronic recurring pain migraine attack, go to a homeopath. You will easily get to say goodbye to your pains by homeopathy.    

Name of some most common homeopathic medicine for pain:-

Apis Mell
Arsenicum Alb
Belladona
Berberis Vulgaris
Bryonia
Cactus G
Cantharis
Colocynthis
Eupatorium Perf
Kali Bich
Kalmia Lat
Ledum Pal
Lycopodium
Natrum Mur
Nux Vomica
Rhododendron
Rhus Tox
Ruta
Sang Can
Sepia
Spigelia
Sulphur

Surgery : Risk Facts

Based on WHO report "An Estimation of Global Volume Of Surgery" published in The Lancet on June 25, 2008.

World Health Organization Published a study on worldwide surgeries. Some important facts about Surgeries:

1. 234 million surgeries are undertaken worldwide every year.
2. 1 in every 25 people undergo some minor or major surgery every year.
3. 7 million patients undergoing surgery have Major complications.
4. 1 million die each year as a result of surgical complications.
5. 3 % to 16 % Inpatient surgeries result in unnecessary complications.
6. 0.4% to 0.8% Death rates from complications during surgery.
7. 5 % to 10% Death rates during major surgery in developing countries.
8. Death from general Anaesthesia alone is high as 1 in 150.
9. In 3% cases of surgeries Infections are reported which cause complications.
10. Surgeries are mostly done for Ischaemic heart disease,Cerebro-vascular disease, Cancers and Orthopedic Injuries.


What wrong happen most commonly in India:-

Cases of surgeries being done on the wrong patient,on the wrong part of his body and surgical equipment being left behind is very common in India.

Comparative Facts :

A. Total expenditure Per head on health ( in US $)

China 277
Russia 583
India 91
Indonesia 118
Iran 604
South Korea 1135
Turkey 557

B. Total Average surgeries per year on 1,00,000 population

China 2659
Russia 4257
India 369
Indonesia 1462
Iran 4744
South Korea 6684
Turkey 4188

C. Expected Rate of annual Operations

China 31900000- 38400000
Russia 5600000- 6500000
India 3700000- 4400000
Indonesia 2900000- 3500000
Iran 2900000- 3600000
South Korea 2900000- 3400000
Turkey 2800000- 3300000


Studies and report by World health Organization suggests that approximately 50% of these complications may be preventable if right " SAFE SURGERY CHECK LIST" applied before and during surgeries.


Homeopathy : Scope and Hope

Homeopathy is helpful in reducing the number of many Minor and Major surgeries. Surgeries for superficial cysts, Ovarian Cysts, Kidney and Bladder Stones , Gall Bladder Stones, Warts Cysts of eyelids , Pus Pockets, Hemorrhoids ( Piles), Fissures ,Fistulas , Appendicitis and some other diseases can be cured by Medicines only.

What is Homeopathy?

Brief Introduction To Homeopathy

Homeopathy has a complete theory and complex concepts of therapeutics. Basic law of homeopathy is its principal of simile. Few basic and very simple explanation of homeopathy are as follows:

(a) Homeopathy is a therapeutic method based on the application of the similia principle, utilizing medicinal substances that, in healthy subjects,produce effects that are similar to the symptoms being treated in ill subjects.

(b) When a healthy organism is perturbed by every physical, chemical, or biological stressor, it produces characteristic signs and symptoms; when caused by a drug, this is regarded as an expression of iatrogenic response or patho-physiological reaction (‘proving’ in the homeopathic medical system).

(c) The provings that describe the characteristic patterns of signs and symptoms, caused in healthy subjects by a number of mineral, vegetable and animal compounds, have been gathered during the past two centuries in the homeopathic ‘Materia Medica’.

(d) When threatened by natural disorder or disease, living organisms show signs and symptoms which are mainly the expression of the efforts to re-establish normal homeodynamics at cellular, tissue and systemic levels including the mind. In chronic conditions, the symptoms also reflect the failure of those efforts, the blockade of regulation system(s), and the pathological adaptation to the disease.

(e) Low doses or high dilutions of a substance which is capable of evoking certain symptoms in healthy subjects, when administered to subjects showing similar symptoms due to natural diseases, may evoke a specific and global secondary healing reaction, thus becoming a potentially effective therapeutic agent.

Homeopathic medicines promote patient's immune system to work strongly against disease process to maintain system's equilibrium again. Even in infectious diseases homeopathic medicines does not act directly against infectious organism. The dose of medicines is very low to work directly against any organism and that is the reason Homeopathic prescriptions are safest without any adverse effect even in children and pregnant women.

Homeopathy is different from all other system of medicines on its principal of individuality. Every patient either in state of health or in disease is different from other one, it means one person's Headache is different from others. Homeopathic medicines can not be prescribed on basis of diagnosis of a disease. All the patients of Migraine can not be prescribed same prescription. If a person get relief by pressure in pain and another person aggravated by pressure in pain,then these two patients would get different prescription in Homeopathy for same disease i.e. Migraine. This is individuality of a patient. Every patient is different from another.

Homeopathy has one more important principal of Totality. When a patient contact a Homeopath for any disease ,for an example Migraine,prescription is not only based on symptoms and signs related to Head. Sign and symptoms are living organism's expression of the effort to re-establish normal homeodynamics. In case of Migraine,these efforts are not only limited to head but all the system show different efforts to maintain normal functioning. So,sign and symptoms related to every system,organ,tissue, changes in behavior pattern, mental attitude are of equal importance. Homeopathic prescriptions are based on Patient's Totality and not merely on sign and symptoms of related disease only.

Homeopathic system of medicine is safest, efficient and accurate for any medical disorder.

Breast Cancer: Facts and Risk

Facts About cancer:

1. 7.4 million (74,00,000) people died of cancer in 2004. And 83.2 million ( 8,32,00,000) people will die of cancer by 2015.
2. In women Breast cancer is was the most common cause of cancer mortality , 16% women death by cancer were caused by breast cancer.
3. Only 22% women of age group 50-69 year ,surveyed in 66 countries, had undergone a mammogram. In india less then 5% women of this group underwent for a Mammogram.
4. In India breast cancer is most common form cancer in women.
5. 1 in 26 women in India are expected to be diagnosed with breast cancer in their lifetime.
6. WHO( world health organistaion) predicts that by 2020, India will be on a par with US and Europe in the incidence of breast cancer - one in every seven women.
7. If breast cancer detected in Stage 1 ,chances of survival are 80% while in stage 3 chances of survival are 20%.
8. At present ,an estimated 100,000 women get diagnosed with breast cancer every year in India.
9. 1 in 10 women diagnosed with cancer in one breast will develop the cancer in the other breast as well.
10. Around 30,000 women die of breast cancer annually.
11. In India ,about 50% patients of breast cancer get diagnosed only at stage 3.
12. In the last 40 years, breast cancer cases have gone up by 30-40% across Indain metros.
13. A 3% per year rise in breast cancer cases in India is predicted.
14. By 2015 there will be approximately 2.5 lakh (2,50,000) new cases of breast cancer in India.

What is good :

Mortality of Breast cancer ,cervical cancer, colorectal cancer, oral cancer can be reduced by screening.


MAMMOGRAPHY:

1. Screening Mammography is an X-Ray examination of the brestes in a woman who is asymptomatic ( Has no symptoms of breast cancer).
2. It's goal is to detect cancer when the cancerous lump is still too small to be felt by a woman or her physician.
3. Mammography can find 90% of breast cancers in women over 50 years and can discover a lump up to two years before it can even be felt.
4. Early detection of small breast cancers improves a woman's chances of successful treatment.
5. Screening mammography is recommended every one or two years for women once they reach age of 40 and every year once they reach age of 50 years.
6. Physicians sometimes begin screening mammography before age 40 in patients who have a strong family history of breast cancer.

Hot Flushes in Menopausal Women

Hot Flushes in Menopausal women


Menopause is defines by at least 12 months of amenorrhea in 50 year old women( with or without increase in serum level of FSH-Follicular Stimulating Hormone) , bilateral oophorectomy in women of child bearing age or negative testing for progestrone in women aged at least 45 years.


Hot flushes are sudden sensations of intense heat ,it mainly affects the upper part of body and lasts from 1 to 5 minutes. Other associated symptoms may be redness of face, heavy perspiration,anxiety,palpitations,irritability, sleeplessness and nocturnal sweating. Hot flushes are most common reason of discomfort during menopause and it reduce quality of life.

Conventional Treatment-

Hormone Replacement therapy (HRT) is advised for hot flushes and other menopausal problems but HRT has severe unfavorable effects.

Homeopathic Treatment-

Homeopathic medicines are prescribed on strict individualizations of patient. Most common medicines advised are Lachesis mutus, Sulphur,Sepia, Sanguinaria, Gloninum, Belladona and few else. Medicines are prescribed on basis of severity of symptoms, mental attitude of patient, environmental modalities,desire and aversion for different things, Temperament, Mood swings and physical constitution of patient.

More then 75% patients feel comfortable with Homeopathic prescriptions in Hot Flushes of Menopause. Noticable reduction in hot flushes and associated other menopausal symptoms improves quality of life.

Hair Falling

Hair Falling

Hair loss is very common disorder among males, females, all age groups and all ethnic groups. There are many patterns of Hair Falling.

A. Baldness- It is not actually hair falling.Hair becomes very fine and colorless instead of falling.Now hairs is called Vellus.
B. Alopecia aerata- It is an autoimmune disorder, body's defense system(immunity) start to destroy hair roots by forming antibodies against Hair roots. It is common among adolescents and young but may effect any age group.
C.Medications used for Gout,Heart diseases,Hypertension,Arthritis,Mental Disorders,Depression and chemotherapy used in Cancer and another cases may cause Hair Falling.
D.Male hormones(Androgens) causes hair loss,this type of hair loss is called Male Pattern Baldness. But this male pattern baldness may occur in females too,because females also have Androgen(Male Hormones).
E.Hair falling May occur in females during pregnancy and when using Birth control pills.Hair falling may continue for 6 months after stopping Birth control pills and after delivering a baby.
F.Large doses of Vitamin A may cause hair loss.

Hair Loss in diseases

A.Thyroid Disorders
B.Anemia- Low hemoglobin level in blood,generally in females.
C.Diabetes
D.Fungus infection of hair roots.
E.Major surgical procedure or some chronic illness
F.Insufficient diet specially low protein diet
G.Allergic Disorders

Few other reasons of Hair Loss

A.Frequent shampoo and conditioning of hair
B.Heat and Chemical treatment on hairs for coloring
C.Perming and Hard combing may weaken the hairs and cause hair falling

Few Facts About Hairs

A.A Person has nearly 50,00,000(5 million) hairs on all over the body. 120,000 hairs only on scalp.
B.Hairs on scalp grows continually for 5 years,after that hair stop to grow and after few weeks it fall out.Then new hair start to grow from same hair root. up to 100 hairs fall everyday normally.
C.Growth of hair depend on health status of person and blood supply to hair roots.

Common Baldness

More then 95% cases of Hair falling are of common baldness. Hairs not actually fall in Baldness but they become very thin,fine and colorless called Vellus.

Alopecia Aerata

Nearly 2% population suffer by Alopecia Areata. Usually it occurs on scalp only but sometimes may involve other part of body too. Pattern of hair loss in Alopecia Areata is different from Male pattern Baldness. Usually hair loss more on one side of scalp(Head).Hairs loss is Rapid in this condition. Alopecia Areata is an Autoimmune disorder, it means body's own immunity produces antibodies against hair roots. And those antibodies destroy the hair roots.Usually hair falls in patches.There may be more then one patch on head.
Sometimes hair falls from all of the scalp(head) and this is known as Alopecia Totalis. And sometimes this process goes further and hair falls from all over the body and now it is called Alopecia Universalis.

Treatment

Conventional Treatment
Common Baldness has no effective treatment. Lotion Minoxidil used to improve blood supply of scalp. A pill Finasteride is used to block the effect of Male Hormones(Androgens) on hair roots. But this medicine can produce Birth Defects on Pregnant Women.
Alopecia Aerata is reversed in 50% cases spontaneously in 6 months to 1 year. But the remaining cases need Treatment.Oral steroids and injections are prescribed but curability is very less. Treatment of Skin by ultraviolet rays may helpful in some cases. And somtimes Immunity suppressive drugs are used.
In conclusion Not any effective treatment is available to treat hair falling in Conventional Therapy. Very few patients get effective cure for hair falling here.

Homeopathic Treatment
Homeopathy offer very effective and permanent cure for most of cases of hair falling. In homeopathy more than 95 drugs are available for hair falling. Selection of medicine depends on Individual features of patient,modalities,behavior pattern, mental attitude,reactions,temperature modalities and coexisting disorders. Homeopathy cure effectively common baldness,Alopecia Aerata, hair falling during pregnancy and after childbirth. Treatment of Hair falling takes long time to cure. Even you will not find any sign of improvement in first few weeks,but take medicines with patience.

Polycystic Ovarian Syndrome

Polycystic Ovarian Syndrome(PCOS)

Also known as Polycystic Ovarian Disease(PCOD)
Polycystic Ovarian Syndrome - PCOS is a disorder which affect a woman's menstrual cycle, hormonal levels, fertility, insulin level, heart, blood vessels and general features. PCOS is the most common hormonal problem in women of reproductive age.It is very common cause of infertility in women( infertility means fail to conceive pregnancy). Near about 7 to 10% of women have PCOS.

PolyCystic Ovarian Syndrome ( PCOS) and Pelvic Inflammatory Disease (PID) are most common causes of Infertility in females.


Common Features in females with PCOS

1.Irregular or no menstrual cycle(Periods).

2.Increased level of Male hormones (androgen) in females.

3.May be small cysts in ovaries. Cyst is a sac full of fluids.

Causes of PCOS

No exact cause is yet known.

1. Females with PCOS have frequently a mother or sister with same disorder. But evidence for genetic link are not yet clearly available.

2.Many patients with PCOS have extra Weight .So researchers are searching for some disorder of production of Insulin hormone in body.Insulin regulates the sugar,starch and other energy needs of body.

3.Level of male hormones(Androgen) increased in blood that causes hairs growth,male pattern baldness. But not exact source of male hormones is yet known.

Symptoms of PCOS

1.Irregular Menstruation or absence of menstruation or irregular bleeding(periods).

2.Infertility - inability to get pregnant.

3.Acne( Acne are not only caused by PCOS),oily skin.

4.Excessive Hairs on face,chest,back and all over the body.

5.Weight Gain or obesity.

6.Pain in pelvic region.

7.High Blood pressure.

8.Baldness of male pattern due to excessive male hormones.

Diagnostic Tests

1.Ultrasonography-Vaginal ultrasonography for finding cysts in ovaries.

2.Hormone tests for male and female hormones.

3.Level of glucose,cholesterol in blood.

4.Insulin Level in Blood.


How Cysts form in Ovaries?

Females have two ovaries,one in each side of uterus. Each ovaries have follicles, filled with liquid and eggs. These follicles may be called cysts. Every month about 20 follicles start to mature but only one follicle success every month,and every month one ovum is excreted in uterus for pregnancy. When every month follicle mature it breaks and release egg.Remaining part of follicle start to produce progesterone.This is normal physiological process and controlled by hormones.

In cases of PCOS secretions of female hormones is insufficient. Not any egg matures. So fluid filled follicles(cysts) does not mature and breaks. Some of them remain as cysts. And they are collected in ovaries month after month. These cysts produce Male hormones(Androgen), and further increase the problem. Because no follicle matures and breaks, so production of progesterone hormone does not start which regulate the menstrual cycle. Defected production of hormone is main cause of irregular menstrual cycle in cases pf PCOS.

Treatment of PCOS

Conventional Treatment

There is no cure for PCOS.Treatment is based on symptoms and problems of every individual patient.

1. In patients who does not want pregnancy

Birth control pills can

-regulate menstrual cycles(periods)

- control extra hair growth by reducing male
hormones.

-control Acne.

But all these effects are only temporary until birth control pills are continue. These pills can not cure PCOS. Only Progesterone pills can also be used for menstrual regulation but these pills can not control Acne and Hair growth.

2.In patients who want Pregnancy

Release of Egg from follicles is necessary for Pregnancy . Hormones as FSH(follicular stimulating hormone), LH(leutinizing hormone) and GnRH(Gonadotropin Release Hormone) are used. 

Clomiphene Citrate is another drug of choice in these cases.

Earlier , wedge resection of ovary(partial oophrectomy) by surgery was done.But this surgical process may cause post operative adhesion's and infertility. These days a new surgical procedure- Laser puncture of cysts- is used with more or less desirable effects.

Outcomes are not much favorable by either medicinal or surgical procedures.


Homeopathic Treatment of PCOS

Homeopathy system of medicine treat patients on basis of complete history, detail sign and symptoms, personality trait, behavioral pattern, mental make up, physical appearance, emotional indulgence and environmental modalities.

 Only removal of cysts from ovaries by surgery or prescribing antagonist hormones for increased Male hormones does not solve the problem, as experience shows with conventional prescribing.

Goal of Homeopathic prescription is to stop the process which cause all these irregularities. Long term treatment is advised for cases of PCOS. After 2-3 month's treatment, most of cases start normal regular periods, ovulatory cycles, reduction in hair growth, acne and normal glucose metabolism.

Patient's suffering from infertility easily gain pregnancy, after few month's treatment.

Homeopathy advises 1 to 3 years of continue treatment for cases of PCOS for permanent cure.


PolyCystic Ovarian Syndrome ( PCOS) and Pelvic Inflammatory Disease (PID) are most common causes of Infertility in females.

Psoriasis

Psoriasis

Psoriasis is a chronic,non-infectious disease. It has thick,well defined plaques of inflammatory silvery scales. 1-3% population suffer by this disease. Psoriasis is a long term disorder, exacerbation and remissions are very common. Generally people of 10-45 year of age suffer more by Psoriasis.
This disease is Non-infectious.But genetic predisposition is found ,it means if one or both parents have Psoriasis then chances of this disease in children are much more.

                                                                © Dr. R. S. Mann 2010

Psoriasis

Read Psoriasis:Few Pictures of cases .

What happen in Psoriasis?

Our skin is made up of two layers, outer layer is epidermis and inner layer is dermis. Our outer layer of skin- Epidermis shed off in every 35 days and a new layer of epidermis grow up and takes place . But in Psoriasis this process of growing new layer of epidermis becomes fast,and whole process now complete in 3 to 5 days in place of normal 35 days.

Types of Psoriasis

1. Plaque Psoriasis:- This is most common type of psoriasis. Lesions have clear cut boundaries, size may be from a few millimeters to several centimeters in size. Psoriasis spots are red and covered with dry-silvery-scales. Usually knees,elbows and back involved in this type of Psoriasis.

2. Guttate Psoriasis:- Psoriasis spots are droplet-shaped small in size less then 1 centimeter usually and covered with scales. Often throat infection by hemolytic streptococcal bacteria is cause of this type of Psoriasis. This type of Psoriasis resolves in few months commonly but later Plaque Psoriasis can develop in these persons.Usually lesions of Guttate Psoriasis are found on trunk,upper arms,thighs,face,ears and scalp.

3. Erythrodermic Psoriasis:- Whole skin becomes red and scaly. this is an Universal pattern of Psoriasis.

4. Pustular Psoriasis:- Pustule(eruptions fill up of Pus) formed on spots of Psoriasis. Fever may or may not be present with these spots. Mostly this type of Psoriasis spots develop on palms and soles.

Causes of Psoriasis

1. Trauma- Trauma or injury to skin may produce Psoriasis. Common sites for Psoriasis is Knees,Elbows has to bear low grade injuries in day to day practices. Trauma to skin must be avoided. Concept of Kobner phenomenon is concerned with this cause of Psoriasis.

2.Infection- Streptococcal bacterial infection of throat may cause guttate Psoriasis.

3. Drugs- Several drugs causes Psoriasis.
A. Anti-Malarial drugs such as hydroxychloroquine which are used as long term therapy for arthritis and lupus.
B. Beta Blockers - Propanolol used in Hypertension(High Blood Pressure).
C. Lithium Salts.
D. Calcium channel blockers and Angiotensin Converting Enzymes(ACE) used for High Blood pressures.
E. Smoking Cessation Drug -Bupropion may cause Psoriasis.

4. Sunlight- Severe ultra violet radiation may increase Psoriasis.

5. Emotional stress,Anxiety may flare up Psoriasis.

Symptoms and Signs of Psoriasis

1. Typical spots of Psoriasis with red, thick,scaly plaques are marked.

2. Itching may or may not be present .

3. Joint pains and inflammation- About 10% patient of psoriasis may have one or more joints involved this is called Psoriatic Arthritis or Arthropathy.

4. Nail changes-Pitting, Ridges and thickening.

5. Hair falling- Psoriasis of scalp presents as falling of flakes from head like dandruff with falling of hairs.

Treatment of Psoriasis

Conventional Medicine

1. Coal Tar preparations - Crude coal tar inhibit DNA synthesis.It is effective in few patients.
2. Dithranol- It also inhibit DNA synthesis and used more commonly.
3. Calcipotriol.
4. Steroid Creams- It is effective but on withdrawal,psoriasis may relapse rapidly.
5. Systemic Treatment for extensive Psoriasis include immunosuppresive drugs such as Methotrexate etc.
6. Phototherapy- Using ultraviolet light is more effective then earlier described treatments. Earlier U VB and PUVA(UVA exposure after injesting Psoralen) were most common forms of Phototherapy. But now a days Narrow Band U VB(NB-UVB) is used with fewer side effects.
Sun light has Ultra Violet(UV) rays of three types- UVA,UVB,UBC. UBA And UVB are used for Psoriasis. Phototherapy is given constantly 3 to 5 times for 2 months at least. After one month of constant phototherapy few signs of improvement starts. And after complete treatment once a week therapy is needed for a very long time.

Homeopathic Treatment

Homeopathy has more then 100 medicines for different types of Psoriasis.Psoriasis patients need a long term therapy from 1 to 3 years. 60 to 80% cases of Psoriasis are curable by homeopathic medicines.Homeopathic medicines are prescribed on patient's Individual pattern of Psoriasis lesions,Modalities according the weather and temperature changes, Personality traits,Behavioral pattern and Mental attitude of patient. General features,family history,co-existing symptoms, temperament, likings/disliking all are important for Homeopathic Prescription.

Bronchitis

Bronchitis

Bronchitis generally refers to an acute inflammation of the air passages within your lungs. It occurs when your trachea (windpipe) and the large and small bronchi (airways) in your lungs become inflamed because of infection or other causes.

• The thin mucous lining of these airways can become irritated and swollen.
• The cells that make up this lining may leak fluids in response to the inflammation.
• Coughing is a reflex that works to clear secretions from your lungs. Often the discomfort of a severe cough leads you to seek medical treatment.
• Both adults and children can get bronchitis. Symptoms are similar for both.
• Infants usually get bronchiolitis, which involves the smaller airways and causes symptoms similar to asthma.
  

Bronchitis Causes

Bronchitis occurs most often during the cold and flu season, usually coupled with an upper respiratory infection.

• Several viruses cause bronchitis, including influenza A and B, which we commonly call "the flu."
• A number of bacteria are known to cause bronchitis, such as Mycoplasma pneumoniae, which causes so–called walking pneumonia.
  
• Bronchitis also can occur when you inhale irritating fumes or dusts. Chemical solvents and smoke, including tobacco smoke, have been linked to acute bronchitis.
• People at increased risk both of getting bronchitis and of having more severe symptoms include the elderly, those with weakened immune systems, smokers, and anyone with repeated exposure to lung irritants.
  

Bronchitis Symptoms

Acute bronchitis most commonly occurs after an upper respiratory infection such as the common cold or a sinus infection. Therefore, you may see symptoms such as fever with chills, muscle aches, nasal congestion, and sore throat.

• Cough is a common symptom of bronchitis. The cough may be dry or may produce phlegm. Significant phlegm production suggests that your lower respiratory tract and the lung itself may be infected and you may have pneumonia.
• The cough may last for more than two weeks. Continued forceful coughing may make your chest and abdominal muscles sore. Cough can be severe enough at times to injure the chest wall or even cause you to pass out.
  
• Wheezing may occur because of the inflammation of your airways. This may leave you short of breath.

When to consult your physician

Although most cases of bronchitis clear up on their own, some people may have complications that their doctor can ease.

• Severe coughing that interferes with rest can be reduced with prescription cough medications.
• Wheezing may respond to an inhaler (which has brochodilatordrugs) which dilates your airways.
• If fever continues beyond four to five days, see your doctor for a physical examination to rule out pneumonia.
  
• See a doctor if you have coughing up blood, rust–colored sputum, or an increased amount of green phlegm.
• If you experience difficulty breathing with or without wheezing ,go to a hospital's emergency department for evaluation and treatment.
  

Exams and Tests

Doctors diagnose bronchitis generally on the basis of your symptoms and a physical examination.

• Usually you will need no blood tests.
• If the doctor suspects you have pneumonia, you may have a chest x–ray.
  
• It may need to measure oxygen saturation (how well oxygen is reaching blood cells) using a sensor placed on a finger.
• Sometimes it needs to examine of phlegm cough up to look for bacteria.
  

Bronchitis Treatment

Self–Care at Home

• By far the majority of bronchitis cases stem from viral infections. This means that most cases of bronchitis are short–term and require nothing more than treatment of symptoms to relieve discomfort.
• Antibiotics will not cure a viral illness.

A.Experts in infectious diseases have been warning for years that overuse of antibiotics is allowing many bacteria to become resistant to the antibiotics available.
B.Doctors often prescribe antibiotics because they feel pressured by people's expectations to receive them. This expectation has been fueled by both misinformation in the media and marketing by drug companies. Don't expect to receive a prescription for an antibiotic if your infection is caused by a virus.

• Acetaminophen ,aspirin or ibuprofen will help with fever and muscle aches.
• Drinking fluids is very important because fever causes the body to lose fluid faster. Lung secretions will be thinner and thus easier to clear when you are well hydrated.
• A cool mist vaporizer or humidifier can help decrease bronchial irritation.
• An over–the–counter cough suppressant may be helpful to ease symptoms.
  

Medical Treatment

Treatment of bronchitis can differ depending on the suspected cause.

A. Medications to help suppress the cough or loosen and clear secretions may be helpful. If you have severe coughing spells that you cannot control, you need prescription for cough suppressants. In some cases only the stronger cough suppressants can stop a vicious cycle of coughing leading to more irritation of the bronchial tubes, which in turn causes more coughing.
B. Bronchodilator inhalers will help open airways and decrease wheezing.
C.Though antibiotics play a limited role in treating bronchitis, they become necessary in some situations if suspicion of a bacterial infection or in people with chronic lung problems.

Homeopathic Treatment

Homeopathy has very effective treatment of Bronchitis. There are more then 150 medicines for Bronchitis. In cases of children and Acute cases of Bronchitis homeopathy cure immediately. Old cases take a long time to cure. Homeopathic medicines are prescribed on basis of Individuality of a patients,his symptom complex, triggering factors, personality traits, modalities of weather and temperature changes, family history,person's mental make up and reaction pattern.

Prevention

A. Stop smoking.
B. Avoid exposure to irritants.Exposure at workplace must be prevented.
C. The dangers of passive smoke are well known. Children should be prevented from passive smoke.
D.Avoiding long exposure to air pollution from heavy traffic may help prevent bronchitis.

Acute Respiratory and Ear complaints: Comparative Study

Homeopathic and conventional treatment for acute respiratory and ear complaints: A comparative study on outcome in the primary care setting

Max Haidvogl* 1, David S Riley* 2, Marianne Heger* ^ 9,3, Sara Brien* 4 , Miek Jong5 , Michael Fischer* 6, George T Lewith* 4 , Gerard Jansen* 7 and André E Thurneysen* 8

1Ludwig Boltzmann Institute for Homeopathy, Graz, Austria

2University of New Mexico School of Medicine and Integrative Medicine Institute, Santa Fe, New Mexico, USA

3HomInt, Karlsruhe, Germany

4Complementary Medicine Research Unit; Primary Medical Care, University of Southhampton, Southhampton, UK

5VSM Geneesmiddelen, Alkmaar, The Netherlands

6ClinResearch GmbH, Cologne, Germany

7Tilburg, The Netherlands

8Institute for Complementary Medicine (KIKOM), University of Bern, Bern, Switzerland

9passed away in 2005



BMC Complementary and Alternative Medicine 2007, 7:7doi:10.1186/1472-6882-7-7

The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1472-6882/7/7
Received: 19 September 2006
Accepted: 2 March 2007
Published: 2 March 2007

© 2007 Haidvogl et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

The aim of this study was to assess the effectiveness of homeopathy compared to conventional treatment in acute respiratory and ear complaints in a primary care setting.

Methods

The study was designed as an international, multi-centre, comparative cohort study of non-randomised design. Patients, presenting themselves with at least one chief complaint: acute (≤ 7 days) runny nose, sore throat, ear pain, sinus pain or cough, were recruited at 57 primary care practices in Austria (8), Germany (8), the Netherlands (7), Russia (6), Spain (6), Ukraine (4), United Kingdom (10) and the USA (8) and given either homeopathic or conventional treatment. Therapy outcome was measured by using the response rate, defined as the proportion of patients experiencing 'complete recovery' or 'major improvement' in each treatment group. The primary outcome criterion was the response rate after 14 days of therapy.

Results

Data of 1,577 patients were evaluated in the full analysis set of which 857 received homeopathic (H) and 720 conventional (C) treatment. The majority of patients in both groups reported their outcome after 14 days of treatment as complete recovery or major improvement (H: 86.9%; C: 86.0%; p = 0.0003 for non-inferiority testing). In the per-protocol set (H: 576 and C: 540 patients) similar results were obtained (H: 87.7%; C: 86.9%; p = 0.0019). Further subgroup analysis of the full analysis set showed no differences of response rates after 14 days in children (H: 88.5%; C: 84.5%) and adults (H: 85.6%; C: 86.6%). The unadjusted odds ratio (OR) of the primary outcome criterion was 1.40 (0.89–2.22) in children and 0.92 (0.63–1.34) in adults. Adjustments for demographic differences at baseline did not significantly alter the OR. The response rates after 7 and 28 days also showed no significant differences between both treatment groups. However, onset of improvement within the first 7 days after treatment was significantly faster upon homeopathic treatment both in children (p = 0.0488) and adults (p = 0.0001). Adverse drug reactions occurred more frequently in adults of the conventional group than in the homeopathic group (C: 7.6%; H: 3.1%, p = 0.0032), whereas in children the occurrence of adverse drug reactions was not significantly different (H: 2.0%; C: 2.4%, p = 0.7838).

Conclusion

In primary care, homeopathic treatment for acute respiratory and ear complaints was not inferior to conventional treatment.


Background

The evidence base for complementary and alternative medicine (CAM) in general is limited and there is certainly a need for more research in areas such as homeopathy [1]. Objective data collection and evaluation is needed to assist physicians in patient care and advance the quality of medical practice [2]. Clinical trials, especially randomised controlled trials (RCTs), are generally accepted as producing the highest level of evidence for medical interventions. Driven by the discovery of new pharmaceutical substances, demands from regulatory authorities for clinical data and the need of physicians for evidence based treatment strategies, the methodology of RCTs became the subject of research itself. Within this context, the strengths and weaknesses of such trials have been debated [3]. Placebo-controlled RCTs are indispensable for the development of pharmaceutical agents with unknown efficacy and safety profiles. Their limitations result from highly standardized study protocols and patient populations, which may create artificial situations that differ from daily practice. Moreover, even the fact that patients are enrolled into a placebo-controlled clinical trial will influence treatment outcome, sometimes leading to high placebo or low verum response rates [4]. Consequently, more practice-based studies have been developed such as pragmatic RCT's or non-randomised cohort studies. Especially non-interventional outcomes studies have only few inclusion and exclusion criteria. Therefore they may provide information about a broad and heterogenous patient population thus resulting in high external validity for daily medical practice. However, the fact that patients are not randomly assigned to treatments in such outcome studies may lead to baseline differences between groups and makes the interpretation of the results more susceptible to bias. This disadvantage may be overcome, at least in part, by the application of statistical methods to control for baseline differences between treatment groups.

Apart from the ongoing discussion about clinical evidence, complementary therapies are well integrated into primary care in most Western countries. Among these, homeopathy is the most frequently used form in various acute and chronic conditions [5-9]. The value of homeopathy in chronic conditions has been demonstrated in several studies. A comprehensive analysis of outcome and cost-effectiveness showed that chronically ill patients had a better overall outcome with homeopathic than with conventional care [10]. Another large-scale observational study showed a positive impact of homeopathy on the health status in a substantial proportion of patients suffering from a wide range of different chronic diseases [11]. To our knowledge, no large comparative cohort studies have been performed to investigate the outcome of homeopathic treatment for acute illnesses. Results of the first phase of this study, the International Integrative Primary Care Outcomes Study 1 (IIPCOS-1), suggest that homeopathic treatment is at least as effective as conventional treatment for acute complaints of the upper and lower respiratory tract [12]. The aim of the present study, IIPCOS-2, was to evaluate on an international basis and in a large sample size if homeopathic treatment is non-inferior to conventional treatment in patients with acute respiratory and ear complaints.

Methods

Study design

IIPCOS-2 is an international, multi-centre, comparative cohort study of non-randomised design, which was conducted between October 1998 and April 2000. Patients suffering from acute respiratory and ear complaints were recruited by physicians in 57 primary care practices in Austria (8), Germany (8), the Netherlands (7), Russia (6), Spain (6), Ukraine (4), United Kingdom (10) and USA (8). The physicians belonged to 3 different groups: providing homeopathic treatment only (22), providing either homeopathic or conventional treatment (9), and providing conventional treatment only (12). The physicians, prescribing primarily homeopathic single remedies, had in addition to their conventional medical qualifications, graduated from a homeopathic training program and at least 5 years experience using homeopathy in their medical practice. The protocol was approved by the International Ethics Committee in Freiburg, Germany. The study was conducted in accordance with the declaration of Helsinki, Good Clinical Practice (GCP) guidelines and national legal requirements.

Patients

Patients older than one month, presenting themselves with at least one of five chief complaints (runny nose, sore throat, ear pain, sinus pain or cough), and onset of symptoms not more than 7 days before, were eligible to participate. Each chief complaint comprised of 5 to 9 individual symptoms, which were rated by the physicians with scores from 0 – not present to 4 – very severe. The mean score for each chief complaint was used to measure severity at baseline. Patients meeting the inclusion criteria, respectively in case of children their parents/legal guardians, were informed by the physician about the nature of the study. Prior to enrolment into the trial each patient/parent had to provide written informed consent to participate. Exclusion criteria were among others severe mental impairment, severe chronic diseases such as spinal cord injuries and alcohol or drug abuse. At centres providing both therapies (mixed centres) the treatment was chosen by the physicians and/or following the patients' preference.

Study protocol

During the initial patient contact the physician documented the onset of chief complaint, severity of symptoms, clinical diagnosis, concomitant medical problems and medication and primary treatment prescribed. Patients completed a questionnaire asking for demographic and health-related information. Additionally some general questions addressed the patients' willingness to pay, patient confidence in health care provider and therapy, treatment preference, willingness to be randomized (at mixed centres only) etc. The patient follow-up was carried out by telephone 7, 14 and 28 days after the initial contact. Independent external study collaborators performed the calls. According to the study protocol they were blinded for the patient's treatment. The following parameters were documented: severity of complaint-related symptoms, time until occurrence of first improvement, therapy outcome (assessed with complete recovery, major improvement, slight improvement, no change or deterioration), patient's satisfaction with the treatment (very satisfied, satisfied, neutral, dissatisfied or very dissatisfied) and general health condition. In case any adverse events had occurred, the physician was informed in order to collect more information and medically assess the case.

The response rates were defined as the proportion of patients assessing themselves as 'completely recovered' or 'major improved' after 7, 14 and 28 days of treatment. The main outcome criterion was the response rate after 14 days. Other outcome criteria were the response rates after 7 and 28 days, time to onset of first improvement (patients' assessments after how many days they had experienced a first improvement), patient satisfaction with treatment and health care provider and the occurrence of adverse events. Adverse events were coded by using the WHO-ART terminology.

A total of 72 selected homeopathic medications in potencies of 12C and higher (manufactured according to the German Homeopathic Pharmacopoeia), were given to the physicians as the basic set of study medication. Nevertheless, the physicians were free to prescribe any other remedy, any other potency or dosage form. Conventional treatment, registered in each participating country, was prescribed by the investigator and picked from a pharmacy.

Data collection and monitoring

Data were collected with a validated remote data entry system that was accessed via the Internet. The physicians entered their data online into electronic case report forms. The remote data entry system checked each entry for completeness and consistency. It recorded all data values with date and time of entry as well as all changes in the database in an audit trail. Access to the database was protected by password identification. Each user had a unique password that was provided in a sealed envelope. After entering was completed, data were transferred via Internet to the data collection centre at the former Institute for Numerical Statistics (IFNS, acquired by Omnicare Inc. in 1999) in Cologne, Germany. Monitoring was performed adherent to GCP-guidelines by an independent clinical monitor. Monitoring visits took place at least twice in order to inspect the course of the trial and to carry out source data verification. A data review tool enabled the monitor to identify missing data values, data values deviating from the normal range and among other things, data needing source verification.

Statistical methods

Data analysis was conducted by ClinResearch, Cologne, Germany, using the statistical software package SAS 9.1.3 under Windows XP Professional. The study was designed to confirm non-inferiority of the primary outcome criterion in the total patient population after homeopathic treatment in comparison to conventional treatment, using the one-sided equivalence test at the 2.5% significance level. The non-inferiority margin was defined by 5%-points. Subgroup analyses were performed on age groups (children: <>

Results

Patients

A total of 2,055 patients suffering from at least one chief complaint (acute runny nose, sore throat, ear pain, sinus pain or cough) were enrolled in the study and given either homeopathic (H: n = 1,220) or conventional treatment (C: n = 829) (Figure 1). Six patients did not receive any treatment and were excluded from further analysis. All patients from the USA and Spain (H: n = 216; C: n = 29) were excluded since telephone interviews were not performed according to the study protocol. For another 227 patients no follow-up data were available because either interviews could not be carried out or the patient withdrew from the study. Data of 1577 patients with at least one follow-up contact were evaluated (full-set analysis), 857 patients in the homeopathy group and 720 patients in the conventional treatment group. For 1116 patients (H: n = 576; C: n = 540) follow-up data on day 14 were documented, being the per-protocol set (Figure 1).

Figure 1.

Patient flow-chart. * All patients who received at least one dose of investigational medication and having at least one follow-up contact.

Upon enrolment in the study, patients, or the patients' legal guardians were asked for their treatment preference. In the homeopathy group, 81% of patients had a preference for homeopathy, 18% had no treatment preference. In the conventional group, 55% of the patients' preferred conventional treatment, 2% homeopathy and 43% had no treatment preference. Patients at mixed centres were additionally asked whether they would agree to be randomized if the choice of treatment was made randomly. With 68.1%, the majority of patients in the homeopathy group refused to be randomized, 30.6% had no problem with randomisation and in 1.3% no remark was given. In the conventional group willingness and unwillingness to be randomized were equally distributed (51.9% yes, 47.9% no, 0.1% no remark).

Baseline characteristics

Demographic data of children (<>



Table 1

Demographic data
Children	Homeopathy, n = 407	Conventional n = 252	p-value, if <>
Male (%)	51.1	50.0
Female (%)	48.9	50.0
Age	6.6 ± 4.3	7.4 ± 4.7	= 0.0282a
BMI	16.6 ± 3.0	17.9 ± 3.7	= 0.0001a
Adults	Homeopathy n = 445	Conventional n = 462	p-value, if <>
Male (%)	24.0	32.3	= 0.0064b
Female (%)	76.0	67.7
Age	37.1 ± 12.5	39.6 ± 13.9	= 0.0124a
BMI	24.3 ± 4.8	25.0 ± 4.5	= 0.0031a
Smoking (%)	16.2	22.3
Full-set analysis values are either expressed as % of total or as mean ± SD, aWilcoxon rank-sum test, bFisher's exact test.

As shown in Table 2, cough was the most frequently reported chief complaint in children, followed by sore throat and ear pain. In adults sore throat was the most frequent, followed by cough and runny nose. The overall distribution of the five chief complaints in children was comparable in both treatment groups, but differed significantly in adults (p = 0.0026, Chi-square test). The mean severity score differed significantly at baseline for 2 out of 5 chief complaints, both in children and adults (Table 2).

Table 2

Distribution and severity score of chief complaints at Day 0
Children	Homeopathy n = 407		Conventional n = 252
Chief complaint	(%)	Severity score	(%)	Severity score	p-valuea if <>
Runny nose	9.8	1.1 ± 0.5	15.5	1.9 ± 0.7	= 0.0001
Sore throat	24.6	1.7 ± 0.6	23.0	1.6 ± 0.6
Ear pain	23.1	1.4 ± 0.6	21.0	1.0 ± 0.5	= 0.0002
Sinus pain	2.0	1.6 ± 0.4	3.6	1.7 ± 0.6
Cough	40.5	0.9 ± 0.5	36.9	1.1 ± 0.6
Adults	Homeopathy n = 445		Conventional n = 462
Chief complaint	%	Severity score	%	Severity score	p-valuea if <>
Runny nose	15.1	1.5 ± 0.8	14.7	1.9 ± 0.7	= 0.0005
Sore throat	43.4	1.6 ± 0.7	32.3	1.5 ± 0.6
Ear pain	3.4	1.0 ± 0.3	5.4	1.3 ± 0.5
Sinus pain	8.3	1.5 ± 0.6	13.4	1.5 ± 0.6
Cough	29.9	1.0 ± 0.5	34.2	1.3 ± 0.5	= 0.0002
Full-set analysis values are either expressed as % of total or as mean ± SD. aWilcoxon rank-sum test, indicating the differences between severity scores (from 0 – not present to 4 – very severe) in the homeopathy and conventional group.

With regard to the diagnosis of the chief complaints, in children otitis media was most frequently diagnosed (H: 18.9%; C: 13.5%) followed by bronchitis (H: 16.7%; C: 10.7%) and laryngitis (H: 12.3%; C: 12.7%). In adults, pharyngitis (H: 23.1%; C: 14.7%), bronchitis (H: 11.5%; C: 17.1%) and tonsillitis (H: 13.9%; C: 8.9%) were most frequently diagnosed. In adults, no significant differences were observed with respect to concomitant medical problems (H: 34.2%; C: 36.6%) or concomitant medication (H: 20.7%; C: 20.1%). In the homeopathic group 21.6% of the children had concomitant medical problems versus 13.5% in conventional group (p = 0.0098; Fisher's exact test). The proportion of children receiving concomitant medication was higher in the homeopathic group (9.1%) than in the conventional group (6.7%) as well but did not reach a statistical significant level (p = 0.3098; Fisher's exact test).

Medication

A total of 62 different homeopathic remedies were prescribed primarily on an individual basis. The top 10 (Table 3) of the most frequently prescribed homeopathic remedies included typical 'acute' remedies and accounted for about 60% of the prescriptions. In the conventional group 190 different medications were prescribed. Most of them were antibiotics followed by nasal preparations and analgesics (Table 3).

Table 3. The most frequently prescribed medications

Table 3

The most frequently prescribed medications
Children		Adults
Homeopathic treatment n = 407	%	Homeopathic treatment n = 445	%
1. Belladonna	13.3	1. Hepar sulphuris	9.7
2. Pulsatilla	10.6	2. Belladonna	8.3
3. Hepar sulphuris	6.6	3. Bryonia alba	7.2
4. Mercurius solubilis	6.4	4. Lycopodium clavatum	7.2
5. Phosphorus	4.9	5. Kalium bichromicum	5.8
6. Bryonia alba	3.7	6. Mercurius solubilis	4.9
7. Calcarea carbonica	3.7	7. Allium cepa	4.5
8. Lycopodium clavatum	3.7	8. Phosphorus	3.4
9. Sulphur	3.7	9. Causticum	3.1
10. Phytolacca decandra	3.4	10. Gelsemium sempervirens	2.7
Conventional treatment n = 252	%	Conventional treatment n = 462	%
1. Antibacterials	28.2	1. Antibacterials	39.4
2. Nasal preparations	22.6	2. Nasal preparations	15.2
3. Analgesics	12.7	3. Analgesics	9.5
4. Stomatological preparations	8.7	4. Cough/cold preparations	8.7
5. Anti-asthmatics	5.6	5. Stomatological preparations	5.2

Treatment outcome

The primary outcome criterion, defined as the percentage of patients with complete recovery or major improvement after 14 days, was first calculated for the total patient population. The one-sided test of the full-set analysis showed non-inferiority of homeopathic in comparison with conventional treatment (H: 86.9%; C: 86.0%; p = 0.0003). These results were confirmed by the analysis on the per-protocol set (including all patients with data at day 14) since similar response rates were obtained in both treatment groups (H: 87.7%; C: 86.9%; p = 0.0019).

The response rates at various time points in children and adults are shown in Figure 2. The primary outcome criterion (response rate at day 14) in children was 88.5% after homeopathic and 84.5% after conventional treatment. In addition, response rates after 7 days (H: 68.8%; C: 64.3%) and 28 days (H: 93.1%; C: 92.5%) did not differ between both treatment groups either. In adults, the response rates after 7 days (H: 71.2%; C: 68.8%), 14 days (H: 85.6%; C: 86.6%, LOCF) and 28 days (H: 93.9%; C: 95.9%; LOCF) of treatment were not significantly different as well.

Figure 2.

Response rates after 7, 14 and 28 days of treatment. Response rates (% of patients with complete recovery or major improvement) at 7, 14 and 28 days after treatment in children and adults. Full-set analysis with last observation carried forward (LOCF) at day 14 and 28. Children n = 659 (homeopathy, 407; conventional, 252) and adults n = 907 (homeopathy, 445; conventional, 462).

Since the majority of patients (> 84%) were fully recovered or major improved after 14 days of treatment, it was of relevance to look at outcome differences within the first 7 days. As shown in Figure 3, the percentage of children experiencing a first improvement at different time points within the first week of treatment was significantly higher in the homeopathy group compared to the conventional group (p = 0.0488). For adults, a similar significant difference in favour of homeopathy (p = 0.0001) was observed.

Figure 3.

Onset of improvement within the first week. Onset of improvement within the first week of treatment (cumulative percentages of patients that experienced their first improvement). Children n = 659 (homeopathy, 407; conventional, 252) and adults n = 907 (homeopathy, 445; conventional, 462). Full-set analysis values with * p = 0.0448 for children and * p = 0.0001 for adults, using the Chi-square test on data points of the whole curve.

Additional analysis on the primary outcome criterion in order to correct for demographic differences at baseline was carried out (Figure 4). The unadjusted odds ratio (OR) of the primary outcome criterion was 1.40 (0.89–2.22) for children and 0.92 (0.63–1.34) for adults. In the subgroup of children, adjustments for age, mean severity and concomitant medical problems had little effect on the OR. The unadjusted OR for the Body-Mass-Index was 1.92 (1.03–3.60) and the only one showing a significant difference in favour of homeopathy. Adjustment for BMI differences between both treatment groups at baseline minimally reduced the OR to 1.89 (1.00–3.57). In adults, individual adjustments for all variables had little to no effect on the OR of the primary outcome criterion (Figure 4).

Figure 4.

Main outcome measure – corrections for baseline. Main outcome measure: response to treatment (complete recovery or major improvement) of full-set analysis data at day 14, unadjusted odds ratio's and adjusted odds ratio's for baseline differences with 95% confidence intervals. Between brackets: the number of responders in the homeopathy group and conventional group, respectively. Odds ratio above 1 indicates a better outcome upon homeopathic treatment.

Another outcome measure was the occurrence of adverse drug reactions. The percentage of children experiencing a suspected adverse drug reaction was not significantly different in both groups (H: 2.0%; C: 2.4%, p = 0.7838, Fisher's exact test). In adults, the number of suspected adverse drug reactions was significantly higher after conventional than after homeopathic treatment (C: 7.6%; H: 3.1%; p = 0.0032, Fisher's exact test). Both in children and adults, the suspected adverse drug reactions occurred predominantly in the body as a whole (upon homeopathic treatment) or in the gastro-intestinal system (upon conventional treatment).

In addition, patients' satisfaction with treatment and healthcare provider was evaluated. Almost all patients in both treatment groups were either satisfied or very satisfied with the treatment after 28 days (children: 95% H; 93% C, adults: 91% H; 95% C). A very high percentage of children (H: 98%; C: 95%) and adults (H: 97%; C: 97%) were either satisfied or very satisfied with the healthcare provider.

Discussion

The overall outcome of the first phase of the IIPCOS study [12] is confirmed in the present study on a larger group of patients and a greater number of medical practices, showing that homeopathic treatment is not inferior to conventional treatment for the treatment of acute respiratory and ear complaints. In IIPCOS-1 the response rate of homeopathically treated patients was with 82.6% significantly higher than in the conventional group. In IIPCOS-2 the response to homeopathic treatment was with 86.9% even higher, confirming the good effectiveness. However, no difference was observed between both treatment groups. This is due to a much higher response rate in the conventional group in IIPCOS-2 of 86.0% compared to 68% in IIPCOS-1. One difference between both studies is that in IIPCOS-2, only patients from Europe were analysed since those recruited at practices from the USA were excluded due to protocol deviations. In IIPCOS-1, the majority of patients included had their residence in the USA. However, despite these differences, the overall conclusion from both studies can be drawn that homeopathy is not inferior to conventional therapy. Due to the study design, the findings of IIPCOS-1 and IIPCOS-2 do not provide firm data on the comparative efficacy of homeopathic and conventional treatment in acute diseases but rather underline the potential value of homeopathy in every day clinical practice. Both studies reflect the situation in every day homeopathic practice in an international setting with average patients receiving the usual treatment of a homeopathic doctor. Furthermore, patients were recruited on the basis of chief complaints and related symptoms, rather than on the clinical diagnoses. This symptomatic approach coincides with the homeopathic nature of prescription by treating each patient individually, based on specific key symptoms and patient characteristics.

In IIPCOS-2, differences for various demographic parameters and symptom-related variables were found between both groups. Thereby the profile of typical patients seeking homeopathic therapy was confirmed [13,14], i.e. they were more likely to be women, younger of age, less likely to smoke and to have a lower BMI. The severity of symptoms at baseline was significantly different between treatment groups as well. However the differences were small and their clinical relevance is doubtful. Indeed regression analysis had little effect on the primary outcome criterion, showing that treatment effects were only minimally affected by selection bias. Based on the unadjusted and adjusted odds ratios of the primary outcome criterion it appears that homeopathic treatment, in comparison to conventional treatment, is more beneficial for children than adults. This observation is in accordance with previous studies in which the improvements after homeopathic treatment were greater in children than in adults [11,13].

Another possible source of bias is that the outcome criteria were assessed by the patients themselves. Since it was not possible to blind patients for their treatment, potential reporting bias from patient's expectations may have influenced the outcome. On the other hand, the patients' reports were collected by independent external study collaborators in order to minimize the influence of the patient's relationship with their physician on the treatment outcome. Although blinding of the external study coordinators was foreseen in the protocol, it cannot be ruled out that they received information from the patient revealing the nature of their medication. Therefore, blinding may not have been guaranteed in each case. Furthermore, it should be noted that at mixed centres, the choice of treatment was made by the physicians and/or following the patients' preference. The treatment decision may have been influenced by the kind or severity of the symptoms or the motivation and expectations of the patient.

Since acute respiratory and ear complaints are self-limiting conditions, it can be argued that the chosen primary outcome criterion after 14 days of treatment is not sufficiently sensitive. Patients experiencing these acute complaints may have undergone spontaneous recovery within 1 to 2 weeks. However, this outcome parameter was taken to confirm and reproduce the results of IIPCOS-1 by using a similar study design. Therefore other outcomes criteria such as the response rate after 7 days of treatment have to be considered more carefully. Moreover, the findings that the percentage of patients experiencing a first improvement within the first week was higher at all time points in the homeopathy group than in the conventional group, are at least supportive of the 14 days finding that homeopathy is not inferior to conventional medicine.

Other observational studies on the comparability of homeopathic treatment and conventional treatment of upper respiratory tract infections (URTI) have shown positive outcomes for homeopathy [15,16]. Recently, the value of homeopathic treatment for the prevention of URTIs has been demonstrated in a controlled clinical trial [17]. The consistent findings in IIPCOS-1 and IIPCOS-2 further contribute to the evidence that homeopathic treatment plays a beneficial role in the primary care of patients. Furthermore, the good tolerability of homeopathic treatment of acute respiratory and ear complaints was confirmed by the low number of patients that experienced adverse drug reactions.

The major limitation of the present study is that patients were not assigned randomly to their treatment group. The majority of patients in the homeopathic group had a strong treatment preference and consequently, they were not willing to be randomized. A similar reluctance towards randomisation has also been reported elsewhere for patients seeking anthroposophic therapy [18]. These results reveal a substantial limitation to the suitability of performing large randomized controlled trials on the efficacy of homeopathy in such a primary care setting.

Conclusion

This comparative cohort study, involving more than 1,500 patients in primary care practices of at least 6 different European countries, demonstrates that homeopathic treatment for acute respiratory and ear complaints was not inferior to conventional treatment. Although no firm conclusions can be drawn about the efficacy of homeopathic treatment, these results certainly contribute to the growing evidence that homeopathy is a safe and beneficial treatment strategy for acute diseases in primary care settings.

Competing interests

MJ is an employee and MHe † was an employee of the HomInt organisation. All other authors have no financial or non-financial competing interest related to the content of the manuscript.

Authors' contributions

International Integrative Primary Care Outcomes Study 2 (IIPCOS-2) collaborators: MH, DR and MHe planned and directed the study. SB, GL, GJ and AT were responsible for data collection. MJ drafted the manuscript. MF performed the statistical analysis. All authors read and approved the final version of the manuscript.

Acknowledgements

This study was carried out by the HomInt organisation, Karlsruhe, Germany. The IIPCOS-2 collaborators would like to thank Sytze de Roock for preparation of tables and figures, Rolf Hövelmann for data analysis, Wolfgang Mayer for monitoring the study and Rainer Lüdtke for his comments on the drafted manuscript. We are especially grateful to the physicians and all the patients for participating in the study.

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